Individual
DR. ALLAN WILLIAM MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1180 WARM SPRINGS HWY, MANCHESTER, GA 31816-1166
(706) 846-2131
(706) 846-3517
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
888T
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
162199146A
—
GA
01
—
4811300001
PALMETTO GBA NSC
GA
Enumeration date
09/23/2005
Last updated
08/05/2021
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